Africa Health News Sept-oct 2009 Final

A WHITAKER GROUP PUBLICATION

SEPTEMBER/OCTOBER 2009

AFRICA HEALTH NEWS 59TH SESSION OF THE WHO REGIONAL COMMITTEE FOR AFRICA

PRESIDENT KAGAME CALLS FOR STRONG HEALTH LEADERSHIP President Paul Kagame of Rwanda called for a renewed commitment to leadership and accountability at the opening of the 59th Session of the World Health Organization (WHO) Regional Committee for Africa held in Kigali, Rwanda, from August 31 to September 4. “Money is essential for achieving development objectives, but greater challenges lie elsewhere - including strong and multi-level leadership, robust policy ownership, appropriate strategy, commitment, hard work, being innovative and accountability,” President Kagame told the gathering of African health ministers and other delegates. “No amount of material or financial resources can transform a nation without a clear political and policy purpose.” He pointed to Rwanda’s success in expanding universal health coverage from 7% in 2003 to 85% in 2008, and the implementation of Performance-based Financing as evidence of what can be achieved when a nation takes ownership of its health challenges. Rwanda’s increased health coverage is largely due to the creation of mutuelles de santé or community prepayment health insurance schemes, which pool the resources of all mutuelle members who then receive services at designated health centers. Under Performance-based Financing, the Government of Rwanda and its partners tie the provision of aid and government support to health outcomes at facilities. By improving outcomes, health care providers can earn bonuses, thereby providing

LEADERS DISCUSS SECURE SUPPLY CHAINS Over 100 African health leaders, including Ministers of Health and senior delegates from 19 African countries attended a dinner on the margins of the WHO Africa region session in Kigali to discuss strategies to secure patient health by ensuring the safety of supply chains in Africa. Dr. Richard Sezibera, Rwanda’s Minister of Health, called on countries and the industry to work closely together to ensure that supply chains remain safe. Speakers also gave examples of best practices in the Ghanaian and Rwandan procurement systems. The dinner was hosted by Global Health Progress (GHP), an initiative that brings research-based biopharmaceutical companies and global health leaders together to improve health in the developing world, Eli Lilly & Company and the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). Other speakers included Dr. Benjamin Kumbour, Deputy Minister of Health, Ghana (now serving as the Minister of Health); Ambassador Zephyr Mutanguha, Director General, CAMERWA; Ms. Suvi Rautio, Regional Chief of Supply, UNICEF; Mr. David Talbot, Director, International Government Affairs, Eli Lilly and Company; and Dr. Ryoko Krause, Director, Biologicals and Vaccines, IFPMA.

incentives and increasing accountability. “Citizens develop a direct stake in health, and can no longer afford to stand on the sidelines precisely because they now realize they can contribute considerably to the improvement of the lives of their children, siblings, parents, or their very own,” the President added. President Kagame also credited this approach for Rwanda’s dramatic reduction in malaria cases in recent years. “We had A Rwandan mother holds up her to have an effective preventamutuelles de santé card tive and curative strategy that emphasized public and private partnerships, assertive community mobilization and a consistent focus on strengthening our national health system, particularly at the district and local levels.” The President thanked Rwanda’s development partners for their assistance in supporting the government’s health goals. He outlined several key features that maximize the impact of aid: ■ National policy ownership with a clearly defined purposed for aid, understood and shared by the provider and receiver; ■ Shared oversight and accountability mechanisms with well-defined indicators to systematically monitor the impact; ■ Embedding aid into the execution of national development strategies and policy priorities; and ■ Built-in human and institutional reinforcement to build and sustain capacity and competence beyond aid. Improved Health Capacity WHO Director-General Dr. Margaret Chan, who also spoke at the opening of the regional session, reported that recent WHO data showed large reductions in child mortality and mortality from malaria as African countries approach universal coverage with recommended malaria interventions. The dramatic improvements, she said, were the result of excellence in research and institutional capacities in Africa, where 11 centers are now conducting phase three trials of a potentially revolutionary malaria vaccine. In addition, Dr. Chan pointed to the “add-on benefits” of malaria control in reducing child mortality, which include quicker identification and management of childhood pneumonia, real-time disease surveillance, and the use of mobile telephony to manage health care. “I believe it is time to stop talking about Africa in terms of sweeping generalizations,” Dr. Chan said. “The region as a whole may not reach the Millennium Development Goals, but there are bright sparks of success, in many areas of health in many countries, that tell a different story. Success builds the momentum for transformational change. Success gives all those same old problems a different perspective. They can be overcome.”

PAGE TWO NEW EFFORT ON MALARIA

HEALTH & FINANCE

AFRICAN LEADERS LAUNCH ALLIANCE TO ELIMINATE DEATHS

KENYA TO BENEFIT FROM PRIVATE EQUITY HEALTH INVESTMENTS

African leaders, gathered at the United Nations General Assembly, launched an ambitious program in September to eliminate malaria deaths in Africa by 2015. The African Leaders Malaria Alliance, made up of the Heads of State of 20 African nations, aims to streamline procurement and distribution of control and treatment methods while advocating keeping malaria high on the international development agenda. The alliance’s first goal is to provide universal access to malaria control methods - insecticide-treated bed nets and indoor residential spraying - to all at-risk Africans by the end of 2010 in the hopes of eliminating all preventable malaria deaths by 2015. Ninety percent of the more than one million deaths from malaria annually occur in Africa, the vast majority of which are children under five and pregnant women. It is estimated that the economic costs of malaria in Africa amount to about $12 billion each year. “We are now creating a critical forum and mechanism for advocacy, action, and followup on the implementation of these noble goals. The goals are ambitious, but I am confident they are achievable,” said Tanzanian President Jakaya Kikwete. The alliance will complement the ambitious plan to combat malaria unveiled in 2008 by the Roll Back Malaria Partnership. The international community has committed $3 billion in support of the plan, which includes the distribution of more than 240 million bed nets by the end of 2010. With bed net distribution tripling over the past five years, malaria deaths

More than 300 million Africans are now covered by insecticide-treated bed nets. The goal of the African Leaders Malaria Alliance is to extend coverage to 700 million Africans by the end of 2010. have declined by up to 60% in some malariaendemic countries. President Kikwete said that the alliance must address critical issues such advocating for increased spending for national malaria programs to establishing comprehensive national prevention and therapy policies. “In scaling up use of insecticide-treated mosquito nets and indoor residence spraying, we need to remind ourselves of the importance of maintaining internationally-agreed standards. In our national malaria control programs, due regard must be given to solving the problems of a shortage of health workers at all levels and ensuring efficient utilization of available resources for scaling-up interventions,” he said.

PHARMACEUTICAL INNOVATION

NEW DRUG TARGETS SLEEPING SICKNESS A new combination drug therapy is now available for trypanosomiasis, or sleeping sickness, the Drugs for Neglected Diseases initiative (DNDi) announced in September. The new treatment, Nifurtimox-Eflornithine Combination Therapy (NECT), is the first advance in 25 years, and will be half the cost of previous treatments and much easier to transport to remote locations. The World Health Organization (WHO) is preparing to send free kits to endemic regions and train health workers on how to administer the new treatment. The drugs were donated by bio-

pharmaceutical companies sanofi-aventis and Bayer Schering Pharma AG. Sleeping sickness threatens 60 million people in 36 countries across sub-Saharan Africa, with about 48,000 people dying from it each year. The development of the NECT kit is the result of a partnership made up of Médecins Sans Frontières; Epicentre; HAT Platform, a network of researchers from five African countries; the Swiss Tropical Institute and the national control programs from the Democratic Republic of the Congo (DRC) and the Republic of the Congo.

Kenya is one of the first countries in Africa to access private equity funds, established specifically for health care investments in Africa, to finance broad-based improvements to its health system. In August, the Government of Kenya announced the country would benefit from capital, made available through the Health in Africa Fund and the Investment Fund for Health in Africa, to improve Kenyatta National Hospital as well as other health services. In 2008, the Government of Kenya’s health financing taskforce developed a public-private partnership financing model to sell to the country’s development partners as the preferred long-term means to improve Kenya’s health system. The taskforce concluded that selling equity in health institutions would inject private sector discipline into their management, and would provide needed capital to increase the training of health care workers and to procure equipment and drugs. “Financing the subsidy gap is a good investment that will unlock the demand side obstacles to health care services in Africa,” Professor Eyitayo Lambo, CEO of International Management and Health Consultants, told Kenya’s Business Daily. The Health in Africa Fund was established in June with the backing of the World Bank’s International Finance Corporation (IFC), the African Development Bank (AfDB), the German development finance agency DEB, and the Bill & Melinda Gates Foundation. The fund plans to make about 30 investments, ranging from $250,000 to $5 million, in health care ventures throughout Africa. The Investment Fund for Health in Africa (IFHA) is a Dutch-led private equity fund dedicated to small and medium size investments in private health care companies in Africa. Its investors include FMO, the entrepreneurial development bank of the Netherlands; Goldman-Sachs investment bank; and the Social Investor Foundation for Africa, which is supported by the private sector. When private equity partners are given a stake in management control, they are likely to exert a positive influence on efficiency, policy and corporate governance of private health services.

PAGE THREE PROTECTING HEALTH WORKERS

BUILDING CAPACITY

NEW PUBLIC-PRIVATE PARTNERSHIP TO IMPROVE BLOOD COLLECTION SAFETY

AFRICAN NATIONS SEEK ACCREDITATION

BD (Becton, Dickinson and Company), a leading global medical technology company, and the US President’s Emergency Plan for AIDS Relief (PEPFAR) announced a joint initiative in August to help protect health workers and patients in Africa by improving blood collection safety in clinics and hospitals. The program, to be implemented in partnership with Ministries of Health in the participating countries, will help health care workers improve their blood-drawing procedures and specimen handling, and will also work to control health workers’ exposure to HIV by providing post-exposure prophylaxis. The three-year initiative - which may be extended by up to two additional years - is scheduled to begin in October in Kenya, and will be expanded to up to four additional PEPFAR focus countries where the Ministries of Health will take the lead in developing individualized policies, guidelines and standard operating procedures for blood drawing and specimen handling. It will ultimately support in-service training for as many as 10,000 health care workers and, when fully implemented, will track as many as two million blood draws within each participating country. “A critical role of international development partners such as PEPFAR is to develop and support national leadership,” said Ambassador Eric Goosby, the US Global AIDS Coordina-

Government health officials from 13 African countries launched the first ever push for accreditation of the continent’s medical laboratories in July, starting a process that many believe will be an historic step in strengthening health systems and providing better care for patients. The five-step accreditation process, developed by the World Health Organization (WHO) Regional Office for Africa, will allow labs to gradually receive credit for improvements with the goal of eventually attaining full international accreditation. The initiative will be supported by the WHO and the US President’s Emergency Plan for AIDS Relief (PEPFAR), with funding from the Clinton Foundation. The 13 countries pursuing accreditation are Botswana, Cameroon, Côte d’Ivoire, Ethiopia, Ghana, Kenya, Malawi, Nigeria, Rwanda, Senegal, Tanzania, Uganda and Zambia. “It’s time for Africa to go in this direction. Accreditation is the only way to be sure a laboratory is a good laboratory,” said Dr. Agnes Binagwaho, Rwanda’s Permanent Secretary of the Ministry of Health. “We cannot provide high quality care, no matter what type of disease we’re fighting, without strong laboratories. This will greatly strengthen our health systems in the short term and the long term. This is all about building sustainable health systems.” The accreditation process will be carried out by the American Society for Clinical Pathology (ASCP) with the assistance of volunteer laboratory professionals who will carry out training programs and standardize the quality of African laboratories. Laboratories are considered the backbone of a well-functioning health system, supporting correct diagnosis and speedy and effective treatment. There are only 28 internationally accredited labs in sub-Saharan Africa, excluding South Africa, all of them belonging to the private sector or international research organizations. “Supporting governments’ efforts to strengthen national health care systems, including laboratory quality management, is essential to ensuring sustainability of countrydriven HIV/AIDS interventions,” said Ambassador Eric Goosby, the US Global AIDS Coordinator. “Efforts like this new lab accreditation process are essential to equipping countries and communities with the tools necessary for progress on health.”

Safer blood collection has become critical in Africa since HIV testing and treatment has dramatically increased. tor. “PEPFAR is proud to partner with BD to invest in health systems strengthening and health work capacity-building for safe blood collection. Efforts like these build the capacity of partner countries, support the scale up of proven HIV interventions, and ultimately help create a sustainable response to HIV/AIDS.” This is the third time that BD has partnered with PEPFAR in a joint initiative. In 2007, BD and PEPFAR launched a five-year program to improve the quality of laboratories in subSaharan Africa, and, in 2008, BD, PEPFAR and the International Council of Nurses announced a three-year, public-private partnership to establish a new Wellness Center for Healthcare Workers in Kampala, Uganda.

EXPANDING ACCESS

GSK TO MAKE LARGE INVESTMENT IN AIDS DRUGS FOR AFRICA GlaxoSmithKline (GSK), the United Kingdom-based biopharmaceutical research company, has announced it will invest up to ₤60 million ($97.6 million) over 10 years to improve research and development and access to HIV/AIDS drugs in Africa. GSK will create a pediatric treatment program - Positive Action for Children - and has granted South African generic drug maker Aspen Pharmacare a royalty-free license to develop a cheaper, generic version of the antiretroviral (ARV) abacavir. GSK acquired a 16% stake in Aspen Pharmacare in May 2009. According to GSK CEO Mr. Andrew Witty, the company is considering making more

drugs “appropriate for use in an African setting” available for license. Of the total investment, ₤50 million ($81.3 million) will go to a fund to support non-governmental organizations working with pregnant women to prevent mother-to-child transmission of HIV. The remaining ₤10 million ($16.3 million) will be seed money to support public-private partnerships to develop AIDS medicines specifically for children. “Our objective for Africa is clear - to make existing medicines as widely available as possible while at the same time ensuring sustained investment into R&D for a new generation of medicines,” said Mr. Witty.

PAGE FOUR STRENGTHENING PANDEMIC RESPONSE

LEADERS IN HEALTH

WHO PROPOSES PREPAREDNESS RESPONSE TO H1N1 FLU PANDEMIC World Health Organization (WHO) Regional Director for Africa Dr. Luis Sambo has proposed a series of measures for strengthening Africa’s response to the current global H1N1 influenza pandemic. In a report to the WHO Regional Committee for Africa session in September, Dr. Sambo proposed raising awareness of the disease through improved communications, updating existing epidemic and pandemic preparedness and response plans, and scaling up surveillance and assessment of the status of the disease. In addition, Dr. Sambo called for an increased capacity for influenza diagnosis, ensuring effective coordination of infection control in health care settings and communities as well as intensified resource mobilization. The WHO Regional Office for Africa has dispatched over a million doses of the antiviral drug oseltamivir and protective equipment to all countries in the Africa region, and has established crisis management teams at the WHO Regional Office in Brazzaville, the Republic of the Congo, and at country base locations in Harare, Zimbabwe; Libreville, Gabon; and Ouagadougou, Burkina Faso.

In addition, the WHO has dispatched a million doses of oseltamivir (an anti-viral medicine) and personal protective equipment to all countries in the African region. In her remarks at the session’s opening, Dr. Chan announced that the WHO had secured pledges totaling 150 million doses of vaccine for the developing world and thanked the pharmaceutical industry, in particular GlaxoSmithKline and sanofi-aventis, for their contributions, adding that she appreciated working in partnership with them. “Last week, WHO and its international humanitarian partners issued a call to action aimed at mobilizing resources and supplies to support developing countries during the pandemic,” Dr. Chan said. “Apart from facilitating the management of acute respiratory illness and pneumonia, actions include building stockpiles of essential medicines to ensure continuity of services for priority conditions such as diarrhoea, malaria, HIV and TB.” As of September 10, the WHO reported that there had been 8,125 confirmed cases of H1N1 in Africa.

PREVENTION

TANZANIAN ANTI-MALARIAL BED NET PLANT TO EXPAND PRODUCTION Vector Health International, a joint venture in Tanzania with Japan-based Sumitomo Chemical and A to Z Textile Mills, announced in August that it was expanding production of anti-malarial, insecticide-treated bed nets from 9.9 million annually to 16.6 million. The capacity expansion will bring the total annual number of Olyset® Nets made in Tanzania to 29 million, and is expected to increase the number employed at the plant from an estimated 4,000 people to 6,000. While the majority of bed nets distributed in Africa are manufactured in Asia, an increasing number are now being made in Africa. Currently, there are six African manufacturers - in Tanzania, Kenya, Nigeria and Uganda - reaching over 6,000 retail outlets in seven African countries. The predecessor program for this commercial bed net industry in Africa began in 1999 with the creation of the $67 million NetMark

project, funded by the US Agency for International Development (USAID). “The US government, through USAID, provided the funding to develop a program to create a public-private partnership in malaria prevention by developing retail markets in selected African countries for insecticide-treated nets,” said Mr. Juan Manuel Urrutia, the Johannesburg-based Deputy Director of NetMark. African manufacturers are expected to sell 21 million nets in 2009, he said, adding that the NetMark project has been so successful it can now sustain itself, even if no more donor funding were available. Insecticide-treated bed nets have proven effective in dramatically lowering the number of malaria cases. Sumitomo provides its Olyset technology free of charge to A to Z Textile Mills, Sumitomo’s partner in Vector Health International. More than half of global production capacity for Olyset Net is in Africa. PREPARED AND DISTRIBUTED BY THE WHITAKER GROUP

DR. GUNTHER FABER CEO, THE HEALTHSTORE FOUNDATION When Dr. Gunther Faber retired in 2008 as Vice President, Sub-Saharan Africa, for bio-pharmaceutical research company GlaxoSmithKline (GSK), he did not Dr. Gunther Faber leave the field of health care. Instead, as the new CEO of The HealthStore Foundation, he took up the challenge of expanding access to affordable and safe medicines and primary health care to East Africans. It was a natural progression for Dr. Faber who throughout his career has been active in efforts to improve access to essential medicines’ The HealthStore Foundation’s Child and Family Wellness (CFW) franchises include micro pharmacies and clinics that provide access to essential medicines and target the most common causes of childhood mortality in Africa. Each franchisee must adhere to uniform systems and training, as well as strict controls on quality backed up by regular inspections. In less than two years on the job, Dr. Faber has brought his management expertise - gained from managing pharmaceutical businesses for GSK in 45 sub-Saharan African countries - to HealthStore franchises in Kenya and Rwanda where he has significantly improved the performance of those franchises. The most valuable aspect of the CFW model, Dr. Faber said, is that nurses own the clinics. This not only makes the clinics sustainable, but ensures that they deliver quality service at least 12 hours a day for six days a week. “An added bonus is that we are creating employment for women in the developing world,” he said. The Foundation’s immediate goal is to expand the model to include 14 African countries with at least 1,200 clinics, providing quality basic health care to about 15.5 million people at a cost of $1.50 to $2.00 a person per year. It hopes to eventually export its innovative micro-franchising model to East Asia and South American.